Bone atrophy in complex regional pain syndrome patients measured by microdensitometry

Abstract

Reports of Investigation Bone atrophy in complex regional pain syndrome patients measured by microdensitometryPurpose: To determine the usefulness of quantitative measurement of bone atrophy in the diagnosis and the longterm follow-up of patients with complex regional pain syndrome (CRPS). The bone-sparing effect of a 5-hydroxytriptamine (5-HT2) antagonist was also studied. Methods: Bone mass was measured by computerized micro-densitometry at the middle position of the second metacarpal. The effect of repeated stellate ganglion blocks (SGBs) three times per week with mepivacaine (n = I I), administration of a 5-l-IT 2 antagonist (sarpogrelate hydrochloride, 300 mg a day po) (n = 12), and combined therapy (n = 10) were compared by micro-densitometry and conventional visual analogue scale (VAS) for analgesia after three months of treatment. Results: In CRPS patients, metacarpal index (comical bone thickness), maximum bone density (cortical bone density), minimum bone density (trabecular bone density), and average bone density were reduced on the affected side (14. I%, 12. I%, 25.0% and 19.3% respectively). The rate of reduction in bone mass correlated with the duration of the disease (P < 0.05). Therapy with the 5-HT 2 receptor antagonist (with or without repeated SGBs) decreased pain intensity (from 6. I 0 to 3.81 with SGB, from 6.30 to 2.91 without SGB, respectively; P < 0.01 ) and bone atrophy evaluated by micro-densitometry (P < 0.05). In contrast, repeated SGBs alone reduced pain intensity (from 6.30 to 2.91; P < 0.01) but did not ameliorate bone atrophy. Conclusion: Bone micro-densitometry is useful in the assessment and follow-up of CRPS and for evaluation of treatment. The 5-HT 2 antagonist, sarpogrelate hydrochloride, is a promising treatment for CRPS patients.

Femoral Neck Hounsfield Units as an Adjunct for Bone Mineral Density After Combat-Related Lower Extremity Amputation

“…11,33 Additional factors such as chronic regional pain syndrome may decrease focal BMD, whereas physiologic vitamin D and calcium scavenging decrease global BMD, predisposing to future fragility fracture even after recovery. 3,34 However, measurement of BMD after trauma is performed infrequently, making these factors difficult to evaluate in real time.…”

Therapeutic Potentials of Sarpogrelate in Cardiovascular Disease*

“…These data suggest the effectiveness of sarpogrelate mainly in the treatment of angina with extensively developed disease (146). In addition, sarpogrelate may reduce pain in anginal patients, since it has also been reported to reduce neuropathic pain in patients with postherpetic neuralgia and reflex sympathetic dystrophy (98,103).…”

Hounsfield Unit-Calculated Bone Mineral Density Loss Following Combat-Related Lower Extremity Amputations

“…Furthermore, even after prosthesis fitting and the initiation of weight-bearing, additional delays in return to full or “new normal” activity levels are routine. Poor nutritional intake compounded by increasing metabolic demands during healing promote the scavenging of minerals from bone and decreased global BMD, predisposing to future fragility fracture even after recovery 1,23 . However, despite the predisposition toward massive bone mineral loss, BMD measurement with DXA after trauma is rarely performed, making the effects of these factors difficult to evaluate in real time.…”